“Improving healthcare and saving lives using mobile technology”

 “naloha”: 

demystifying the mHealth project in Kilfi.

Sponsored by Rotary Club of Kilifi and Rotary Club of Vinnings (Atlanta, USA) through the KilifiKids Initiative.

Implemented by Medic Mobile – Rural Health Care Systems specialists.

Improving healthcare and saving lives

using mobile technology”

                                            A Community Health Worker gets baby temperature and submits records via SMS                                              ( Photo courtesy of Mali Health Organizing Project)

 “There can be no real growth without healthy populations. 
No sustainable development without tackling disease and malnutrition. 
 No international security without assisting crisis-ridden countries. And no hope for the spread of freedom, democracy and human dignity unless we treat health as a basic human right.”
 Gro Brundtland, Director-General, World HealthOrganization1998-2003

Naloha – a MijiKenda word meaning “I dream” - is a noble project that brings in partnership between the Ministry of Health (through the Kilifi District Hospital) and the Rotary Club of Kilifi. It was conceived on the basis that Healthcare is the primary concern of any healthy society.

Its formation follows reports in scientific journals on the high rate of malnutrition in Kilifi district in children under 5 years of age, as well as the high rate of infection with communicable diseases among children and pregnant mothers. Adherence to drug administration, turn up for appointments, referrals and high rates of default for key immunizations and checkups amongst patients have been a main driving force towards the establishment of this project. Mobile technology growth for personal use has been on the rise in Africa, and Kenya area has embraced the same within remarkable rates. The project therefore seeks to make use of the mobile network coverage and use for successful implementation.

With funding from Rotary International and the generous support of KilifiKids (a US based NGO), have managed to successfully implement Phase I of the project in 2009-2011, whose main target was improved reporting by Health facilities of Kilifi District. Naloha is the Phase II implementation of the project and seeks to leverage the use of mobile technology towards sustainable rural health care.

The Phase II of the project will be implemented with technical assistance from Medic Mobile, a US based NGO that has a worldwide presence supporting use of Mobile phone based computer systems in rural Healthcare. Medic Mobile will work closely with the Ministry of Health, through KDH, in Kilifi and Ganze to see a smooth take off.

Why mHealth ?

    I.      What is mHealth? – a short form of mobile Health. Mobile phone, a portable communication device; Health – a basic human right for survival. mHealth conotates to the use of mobile phone technology to ease access of healthcare. It is a development of electronic Health Information System (eHIS) commonly used in developed countries and made possible by use of electronic media capitalizing on use of computer systems.

   II.      What is the project objective? The core objective of this project is to leverage the use of mobile technology to improve on healthcare uptake in rural Kilifi. Reducing the rates of malnutrition being the original objective, the IMCI approach becomes the main block and offers a strategic direction to the mHealth project.

  III. What does mHealth involve? In mHealth mobile phones and texting are the main features, health information is communicated to and fro via text messages popularly known as SMS - Short Messaging Service. A computer system that allows for easy access of the texts is involved and is located centrally to manage the entire mHealth initiative.

 IV.      How is mHealth different from other electronic health systems? – Other electronic systems involve managing patient information but lack an interface to communicate with the patient. mHealth SMS system allows health facility staff to store patient records and information as well as to communicate to the patients via the sms facility that is available in all mobile phones. Though it is not easy to frame text messages, this project will make use of SMS templates for standard texting and unstructured SMSs for general texting. The participants will therefore be trained on how to access the template SMSs and how to fill them in. The training shall ensure that all the messaging settings are set correctly to allow the user to know when text has been delivered to the intended receiver. Participants will be taken through the entire setup to ensure that the correct message Centre and values are selected.

       Why use mobile phones?

Mobile phone coverage in Kenya stands at 62% of the population with over 80% network coverage round the country. Mobile use literacy is however far high than the coverage and usage statistics with an estimated 80%+ of the population being able to use the device. Texting is quite popular within the Kenyan cellular context with custom texts like “Please call me” for callers without airtime in their phones being quite popular. Messaging therefore is a familiar tool to most of the users.

  Why Kilifi-Ganze, Kenya?

 Kenya is one of the highly developing countries in Africa. Access to proper healthcare in the rural areas remains a great challenge. Kilifi has been ranked as one of the poorest districts in Kenya, leading to high cases of infectious diseases, malnutrition and other childhood diseases. Ganze is one of the areas identified by the project as a beneficiary owing to the fact that it has one of the most active community units managed by a team of approximately forty Community Health Workers (CHWs).

The implementing partners undertook a pilot phase in Ganze with the Pentanguo CHWs. The Unit is served by the Ganze Health Facility that has a Clinical Officer and Community Health Extension Workers (CHEWS). The harmonious working relationship between the parties involved makes the choice of Ganze quite strategic for the pilot.

Once project is deemed successful in the pilot, it will be scaled up to other health units within the district and hopefully to the entire county with regular recommendations made to the Ministry of Health at a national levels.

Why work with CHWs?

Community Health Workers (CHW) are the primary healthcare givers in rural Kenya. These are community volunteers who are available to support their communities in any health related issues.

The CHW network has been strong in Kilifi district with a relatively good social motivation that has seen the turnover levels remain to the bare minimum. A mixture of men and women CHWs makes it so unique and demonstrates the appreciation of healthcare by the community.

Each CHW manages an average of 20 households with an average of 5 to 10 house members. More focus is given to children under five years and pregnant mothers, who lie within a high risk zone.

This project thus comes in to complement the existing efforts CHWs are committing to their own community.

The project will initially work with a group of 40 CHWs then expand as required.
 
Roles of the different partners

Naloha will be implemented by five main partners ;

1.  Rotary Club of Kilifi / Rotary International
2.  Kilifi Kids
3.  Medics Mobile
4.  Ministry of Health
5.  CHWs

Rotary International

Disease prevention and treatment is one of Rotary's areas of focus. RI is the core financier of the project through the Rotary Club of Kilifi and Rotary Club of Vinnings, who are the primary partners, will implement and steer the project to succession.

Kilifi Kids

A USA based NGO that receives funding from Rotary International and is responsible for research and development of the project. They are the main interface between Rotary Club of Kilifi and Rotary International.

Medic Mobile

These are the technical back stoppers and key implementers of the project. With mobile phone systems, technical experience and resource base, Medic Mobile runs the show of ensuring training, procurement and actual implementation of the project.

They provide progress reports to Kilifi Kids and have a local representative to work on the day to day activities.

Ministry of Health

The Government of Kenya through the Ministry of Health and Kilifi District Hospital are the main duty bearers of the healthcare system in Kilifi district. Through the department of Health records the Ministry provides the technical support and offers good will and liaison with the community based system. Their key role is to ensure that the successes of the project are shared across board and provide a harmonious working relationship between the primary implementers and the healthcare channels.

Community Health Workers –CHWs

These are the working group that will determine the success of the project as they are the ones to run the actual interventions. They will be required to ensure that the working equipment is maintained in good working condition and any loses/ malfunctions reported ASAP.

For the success of the project, text messages are very key and thus the CHWs will be held responsible to sending different texts for the different interventions.

Project Use cases

This project revolves around four use cases that relate to the project area;

1.  Registration of newborns and pregnant mothers

2.  Referrals

3.  Appointment scheduling and monitoring

4.  Defaulter tracing

Registration of newborns and pregnant mothers

A generic SMS will be generated and send to the SMS system that will contain the name of the child /mother , date of birth / conception. With this information the system will automatically schedule the above for different appointments

Referrals

Once a CHW meets a patient in the field, they normally are given a referral sheet that will facilitate visit to the health facility. Once this has been done, the CHW will sent a referral SMS/ Text such that by the time the patient gets to the facility they will already be in the queue. Good enough for emergencies where immediate support can be offered.

Appointment Scheduling and monitoring

Once different appointments have been scheduled during registration, reminder texts will be sent to CHWs and sometimes to patients to remind them of their appointment. This will be sent 2 days before the appointment.

Defaulter tracing

A defaulter here in refers to any patient who does not appear for their scheduled visit. Within 5 days of defaulting the system will be set to generate a text specific on the patient and appointment name they have defaulted. This shall be sent to the CHW and possibly the patient. With this the facility would be able to catch up with defaulters within the week.
 
FrontlineSMS and Patient View

FrontlineSMS is a bulk SMS platform that allows for use of a GSM modem/gateway to link up with a computer system to send and receive texts. Patient view on other hand is a plugin software that works hand in hand with frontlinesms to store patient records and at the same time communicate to CHWs and patients via texting. The software shall be used and training shall be offered to facility staff.